Hernia[JOURNAL]
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200 papers
Concurrent validity and agreement of the HerniaCare Lab device for abdominal wall strength assessment.
Gil Delgado JL, Rangel Cascajosa C, Sánchez Arteaga A … +2 more , Tallón Aguilar L, Sañudo Corrales B
Hernia · 2026 Mar · PMID 41806149 · Full text
PURPOSE: Currently, no standardized, low-cost, and portable method is available for assessing abdominal wall strength in patients with incisional hernias, addressing the limitations of traditional dynamometry. METHODS: T...
PURPOSE: Currently, no standardized, low-cost, and portable method is available for assessing abdominal wall strength in patients with incisional hernias, addressing the limitations of traditional dynamometry. METHODS: This cross-sectional validation study compared the HerniaCare Lab device performance with the Activforce 2 hand-held dynamometer in92 adults diagnosed with abdominal wall hernias. Isometric trunk flexion strength was measured under identical conditions, and agreement between devices was analyzed using non-parametric tests, correlation, and concordance statistics. RESULTS: The HerniaCare Lab showed systematically higher strength values than the Activforce 2 (mean difference = + 22.3 N, p < 0.001) but demonstrated a very strong positive correlation (ρ = 0.95, p < 0.001) and good concordance (CCC = 0.89). Bland–Altman analysis revealed a mean bias of + 24.9 N with 95% limits of agreement from − 17.7 to+ 67.5 N, and a slight proportional bias at higher force levels. CONCLUSION: Despite predictable overestimation, the HerniaCare Lab exhibits strong concurrent validity and good agreement with an established reference device, supporting its potential clinical utility for objective, reproducible, and accessible assessment of abdominal wall strength in surgical populations.
From hands to handles: a modern duel between laparoscopic TEP and robotic TAPP.
Mun JY, Yoo N, Kye BH
Hernia · 2026 Mar · PMID 41790344 · Publisher ↗
BACKGROUND: Robotic surgery has emerged as a modern alternative to conventional laparoscopic approaches for inguinal hernia repair. While the robotic transabdominal preperitoneal (TAPP, RTA group) technique offers improv...
BACKGROUND: Robotic surgery has emerged as a modern alternative to conventional laparoscopic approaches for inguinal hernia repair. While the robotic transabdominal preperitoneal (TAPP, RTA group) technique offers improved dexterity and visualization, its clinical benefit over laparoscopic totally extraperitoneal (TEP, LTE group) repair remains under debate. METHODS: This retrospective study included 332 patients who underwent inguinal hernia surgery at a single institution between April 2021 and December 2023. After excluding cases of open hernia repair and laparoscopic TAPP, 191 patients underwent laparoscopic TEP (LTE group) and 67 underwent robotic TAPP (RTA group). Propensity score matching (1:1) was performed based on demographic and clinical variables, yielding 67 patients in each group for comparison. Operative time, intraoperative complications, and other surgical outcomes were analyzed. RESULTS: The RTA group showed significantly longer operative times compared to the LTE group for both unilateral and bilateral cases. However, intraoperative complications such as peritoneal tearing and bleeding were fewer in the RTA group, with no intraoperative conversions observed, and no postoperative return-to-OR events occurred. A temporal trend analysis also revealed a gradual decrease in operative time for RTA following the initial learning period. CONCLUSIONS: While robotic TAPP requires longer operative time, it demonstrated fewer intraoperative complications and stable postoperative outcomes. These findings suggest that robotic TAPP may be a feasible alternative in selected patients.
Full-thickness skin and dermal grafts as abdominal wall augmentation in ventral hernia repairs - a systematic review.
Carvalho AC, Mansur MS, Almeida MFG … +8 more , Bennet WC, Figueiredo LO, Neto C, Campolina COC, Hubner PNV, Furtado TA, Abras GM, Garcia DPC
Hernia · 2026 Mar · PMID 41790303 · Publisher ↗
PURPOSE: To identify the current literature on the use of skin and dermal grafts as abdominal wall reinforcement methods in ventral hernia repair. METHODS: In accordance with the Cochrane and PRISMA guidelines, PubMed, S...
PURPOSE: To identify the current literature on the use of skin and dermal grafts as abdominal wall reinforcement methods in ventral hernia repair. METHODS: In accordance with the Cochrane and PRISMA guidelines, PubMed, SCOPUS and Cochrane databases were searched. Studies that highlighted the use of autologous dermal and skin grafts for reinforcement in abdominal wall reconstruction were included. There was no publication date restriction for inclusion in this review, but only studies published in English, Portuguese and Spanish were included for final analysis. Cochrane Risk of Bias Assessment Tool (ROB2) and Joanna Briggs Institute Case Series Critical Appraisal tool were used for publication bias assessment. RESULTS: Initial search obtained 705 studies. After removing 224 duplicate records and ineligible studies, 14 articles were selected for comprehensive review and 12 were included in the final analysis: 4 experimental studies, 6 observational series or reports, and 2 randomized controlled trials. A total of 390 patients underwent hernia repair with autologous graft, with a mean follow-up of 19 months. CONCLUSION: Autologous dermal grafts and full-thickness skin reinforcement of the abdominal wall have been described as feasible approaches for abdominal wall reconstruction. Future research should aim to standardize procedural techniques and establish clear indications aligned with current hernia classification systems.
Robotic repair of Post-Transplant lateral incisional hernias: outcomes in complex hernia management.
da Silveira CB, Kapani N, Rasador AD … +5 more , Austin C, Salevitz N, Deka V, Gillespie T, Ballecer C
Hernia · 2026 Mar · PMID 41790299 · Publisher ↗
INTRODUCTION: Post-transplant incisional hernias (PTIH) are a common complication in transplant patients, arising due to chronic immunosuppression, associated comorbidities, and the type of incisions used, most commonly...
INTRODUCTION: Post-transplant incisional hernias (PTIH) are a common complication in transplant patients, arising due to chronic immunosuppression, associated comorbidities, and the type of incisions used, most commonly lateral. PTIH repair is complex, frequently requiring abdominal wall reconstruction techniques, including transversus abdominis release (TAR). The robotic platform offers enhanced anatomical identification and precision, particularly in cases where the dissection plane is limited and complex, improving surgeons’ dexterity. Our objective was to evaluate the management and outcomes of robotic surgery for the repair of complex PTIH. METHODS: Patients referred to our hernia center with a history of solid organ transplantation were identified through a retrospective review. Those who underwent robotic surgery for PTIH were selected for the study. Our institution’s protocol includes preoperative rehabilitation for all patients. The decision to perform TAR was based on hernia size, the presence of loss of domain, and the patient’s anatomy. Data on patient demographics, hernia characteristics, perioperative factors, and postoperative outcomes were collected. RESULTS: A total of 24 patients were identified. 10 patients (41.7%) had a history of liver transplantation, while 14 (58.3%) had received a kidney transplant. Eight patients (33.3%) had a recurrent hernia, and 20 patients (83.3%) required TAR. The mean defect width was 16.5 cm (6.4). No intraoperative complications were observed, but one patient required conversion to open surgery. One patient (4.2%) presented to the emergency department for acute kidney injury and Clostridium difficile infection but did not require readmission. Seven patients (29.2%) experienced surgical site occurrences, including five (20.8%) with superficial seromas and two (8.3%) with hematomas. Only one (4.2%) seroma required percutaneous drainage. No hernia recurrences were noted during a follow-up of 11.2 (3.3–14.3) months. Three patients (12.5%) developed robotic port-related hernias, while one (4.2%) patient experienced chronic abdominal pain. CONCLUSION: Robotic repair of PTIH is an effective approach, demonstrating low complication rates and hernia recurrences at medium-term follow-up. The use of TAR in complex cases enhances surgical experience and dexterity, especially in lateral hernias.
Patients' motivation for undergoing elective repair of a primary ventral hernia: a Danish nationwide cohort study.
Gram-Hanssen A, Baker JJ, Reistrup H … +1 more , Rosenberg J
Hernia · 2026 Mar · PMID 41790288 · Full text
PURPOSE: This study aimed to explore patient motivations for undergoing elective repair of a primary ventral hernia and to estimate the proportion of patients who underwent surgery for indications that are not traditiona...
PURPOSE: This study aimed to explore patient motivations for undergoing elective repair of a primary ventral hernia and to estimate the proportion of patients who underwent surgery for indications that are not traditionally prioritized in surgical decision-making. METHODS: This descriptive mixed-methods study was based on a nationwide survey of Danish patients who had undergone elective repair of an umbilical or epigastric hernia between 2014 and 2024. Data were collected through structured survey questions on predefined motivational factors and linked to national clinical registries. Qualitative free-text responses were analyzed using systematic text condensation to provide contextual understanding of patient motivations. The study forms part of the AFTERHERNIA Project, a series of nationwide studies investigating patient-reported outcomes after groin and ventral hernia surgery in Denmark. RESULTS: A total of 18,753 participants completed the survey, corresponding to a response rate of 82%. The most frequently reported motivations for surgery were pain or discomfort (63%), concerns about hernia growth (39%), and doctors’ recommendations (34%). 12% of participants selected only reasons classified as motivations that are not traditionally prioritized in surgical decision-making. (cosmetic concerns, fear of growth, fear of incarceration, or emotional impact). The qualitative analysis supported these findings, identifying seven themes that reflected symptom burden, professional guidance, and contextual or practical factors as key drivers of patient decision-making. CONCLUSION: About one in eight patients underwent elective repair of a primary ventral hernia motivated by indications that are not traditionally prioritized in surgical decision-making. However, most respondents were motivated by physical symptoms or professional advice.
Effect of posterior rectus sheath closure on outcomes of enhanced total extraperitoneal ventral hernia repair.
Halpern D, Panahi A, Cordero K … +4 more , Pan J, Pacheco TBS, Joutovsky B, Halpern D
Hernia · 2026 Mar · PMID 41790287 · Publisher ↗
PURPOSE: The enhanced-view totally extraperitoneal (eTEP) approach to ventral hernia repair offers durable retro muscular reconstruction with favorable cosmetic outcomes, yet postoperative midline bulge remains a concern...
PURPOSE: The enhanced-view totally extraperitoneal (eTEP) approach to ventral hernia repair offers durable retro muscular reconstruction with favorable cosmetic outcomes, yet postoperative midline bulge remains a concern. We aimed to evaluate the effect of posterior rectus sheath (PRS) closure on abdominal wall morphology and clinical outcomes after robotic eTEP repair. METHODS: Retrospective review was done on patients undergoing robotic eTEP retro rectus VHR with PRS closure. Distance between the lineae semilunaris was measured at three timepoints: pre-closure, after anterior fascial closure, and after PRS closure. The PRS-closure cohort was compared with a historical control cohort from a prior institutional study of patients undergoing repair without PRS closure. Postoperative midline bulge was assessed at follow-up and demographic as well as operative characteristics and early outcomes were compared between the groups. RESULTS: Twenty-seven patients underwent eTEP with PRS closure. The mean semilunar distance decreased from 21.3 cm pre-closure to 19.5 cm after anterior closure (1.8 cm), then to 16.4 cm after PRS closure (additional 4.9 cm; total 6.7 cm; p < 0.001). Postoperative bulge occurred in 18.5% with PRS closure versus 21.8% without PRS closure (p = 0.794). There were no 30-day readmissions or early recurrences. CONCLUSIONS: Midline fascial closure without PRS closure narrows semilunar distance by 1.8 cm; PRS closure provides an additional 4.9 cm reduction, enabling a narrower mesh underlay without affecting early recurrence. The impact of PRS closure on postoperative midline bulge could not be definitively determined. Surgeons should recognize these structural changes and close the PRS selectively; larger, long-term studies are needed.
Comparison of facial defect closure and non-fascial closure in ventral hernia repair: A systematic review and Meta-analysis of randomized controlled trials with trial sequential analysis.
Alzoubi M, Saleh AO, Hageen AW … +6 more , Aldeeb OM, Hanoun R, Alfreijat TM, Alkhateeb R, Shatnawi K, Hilal MA
Hernia · 2026 Mar · PMID 41790286 · Publisher ↗
BACKGROUND: Laparoscopic ventral hernia repair (LVHR) is widely used due to its minimally invasive benefits. However, traditional IPOM without fascial defect closure (FDC) has been associated with variable complications,...
BACKGROUND: Laparoscopic ventral hernia repair (LVHR) is widely used due to its minimally invasive benefits. However, traditional IPOM without fascial defect closure (FDC) has been associated with variable complications, prompting interest in techniques incorporating FDC, such as IPOM-plus and hybrid approaches. Ventral hernia repair remains a common surgical procedure, yet the optimal management of the FDC versus non-FDC remains controversial. We conducted this systematic review and meta-analysis to compare the safety and efficacy of these methods. METHODS: We searched PubMed, Web of Science, SCOPUS, CENTRAL, and Clinicaltrials.gov up to September 2025. Randomized controlled trials (RCT) comparing fascial defect closure versus non-closure in LVHR were eligible. Pooled effect was calculated by Random-effect model with 95%CI. Heterogeneity was assessed using the I tool. Sensitivity, subgroup analyses, and trial sequential analysis were performed to assess the robustness of the results.PROSPERO ID: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251231261 . RESULTS: Thirteen RCTs, comprising a total of 1482 patients, were included. No significant difference was found between the FDC and the non-FDC in terms of diagnosis of recurrence radiologically (OR:0.69,95%CI: [0.33; 1.42], p = 0.3103) or clinically (OR:0.70,95%CI: [0.39; 1.26], p = 0.2357), or in diagnosis of seroma radiologically (OR:0.68,[0.33; 1.40], p = 0.2987) or clinically (OR:0.79, 95%CI: [0.49; 1.26], p = 0.3205). FDC was associated with longer operative time (MD:7.64,95%CI: [2.33; 12.95], p = 0.0048) and slightly higher postoperative pain (at day-1:SMD:0.36,95%CI: [0.07; 0.65]) and at day-2:SMD:0.31,95%CI: [0.05; 0.57], p = 0.0175). Secondary outcomes, including infection, mesh bulging, reoperation for recurrence, chronic pain, and quality of life, were also found to be statistically insignificant. Trial sequential analysis reinforced the inconclusiveness of the evidence and that additional trials are needed. LIMITATION: Despite we included only RCTs, the available evidence is limited by inadequate reporting of hernia defect size and insufficient follow-up durations, which restrict definitive recommendations for routine FDC. CONCLUSION: FDC and non-FDC were comparable in terms of LVHR in recurrence and seroma rates. FDC was associated with longer operative time and post-operative pain. The current available evidence is insufficient to support the routine use of FDC, and further randomized trials are needed to explore its role and accurately identify patients who would benefit the most.
No single superior technique: A network meta-analysis of open, laparoscopic, endoscopic, robotic and hybrid techniques of incisional and ventral hernia repair.
Dhal J, Bansal VK, Tewari N … +5 more , Asuri K, Prajapati OP, Upadhyay AD, Rai S, Anand A
Hernia · 2026 Mar · PMID 41790274 · Publisher ↗
PURPOSE: Incisional and ventral hernia pose a complex surgical challenge with no consensus on the most appropriate repair technique. This study aimed to compare the short-term and long-term outcomes following open and mi...
PURPOSE: Incisional and ventral hernia pose a complex surgical challenge with no consensus on the most appropriate repair technique. This study aimed to compare the short-term and long-term outcomes following open and minimally invasive techniques of incisional and ventral hernia repair. METHODS: Electronic search was conducted in PubMed, Scopus, Embase, Web of Science, LILACS and Cochrane CENTRAL databases, and Google Scholar, last date of search being 1 January, 2025, to identify randomized trials comparing any two techniques of incisional and ventral hernia repair in adults, based on clinical outcomes such as recurrence, intraoperative and postoperative complications, or patient-reported outcomes. Risk of bias was assessed using Cochrane RoB2 tool. Statistical analysis was done using MetaInsight v6.0.1 and Stata version 16, using a random-effects model. RESULTS: Overall, 3229 articles were retrieved, of which 45 full texts were screened. Finally, 28 eligible studies, involving 3,162 patients were analysed. High risk of bias was observed in majority of studies. The primary outcomes of recurrence, and quality of life (QoL) were comparable across different techniques. Operative time was significantly longer in the robotic technique while length of hospital stay was significantly longer for the open technique. There were no significant differences in terms of intraoperative or postoperative complications. GRADE approach revealed quality of evidence to be low to moderate. CONCLUSIONS: All open and minimally invasive techniques are essentially comparable in terms of short-term and long-term outcomes. An individualized approach can thus be expected to render excellent outcomes following any repair technique.
Incisional hernia after kidney transplantation: a systematic review and proposal of a peri-transplant risk scoring system for tailored preventive surgical planning.
El Hennawy HM, Safar O, Aboalsamh GA … +6 more , Lamy S, Almalki AH, Sadagah LF, Tawahri I, Shazly AN, Jaber TM
Hernia · 2026 Mar · PMID 41790263 · Publisher ↗
BACKGROUND: Incisional hernia (IH) is a common complication after kidney transplantation, associated with significant morbidity, graft risk, and healthcare burden. Its etiology is multifactorial, but recent high-quality...
BACKGROUND: Incisional hernia (IH) is a common complication after kidney transplantation, associated with significant morbidity, graft risk, and healthcare burden. Its etiology is multifactorial, but recent high-quality evidence identified wound closure technique as the most important modifiable predictor Huitfeldt et al. (Hernia: J Hernias Abdom Wall Surg 29(1):256 , 2025). METHODS: We conducted a systematic review in accordance with PRISMA guidelines, searching databases through August 2025. Twenty studies involving 16,018 kidney transplant recipients were included. Reported risk factors were qualitatively and quantitatively synthesized, and weighted points were assigned to develop the Incisional Hernia Risk Scoring System (IH-RSS). RESULTS: The pooled incidence of IH was 4% (95% CI: 3–5%). Among affected patients, 61% required repair and 16% experienced recurrence. Independent predictors included peritoneal dialysis, obesity (BMI > 30), advanced age, prior abdominal surgery, and surgical site infection. The strongest modifiable factor was the wound closure technique (modified Israelsson method), which reduced the odds of IH by 83%. The IH-RSS stratifies patients into low (0–5), moderate (6–10), and high (> 10) risk groups, with corresponding preventive strategies, including reinforced closure, incision selection, and selective prophylactic mesh placement. CONCLUSION: The IH-RSS represents the first comprehensive, transplant-specific, derivation-level risk scoring framework for incisional hernia after kidney transplantation. It is a proposed tool whose clinical utility requires validation. Prospective, multicenter validation is now non-negotiable to establish its predictive accuracy and confirm its role in improving long-term surgical outcomes for kidney transplant recipients before any clinical adoption can be recommended.
The impact of a preoperative rehabilitation program on weight loss, surgical decision-making, and postoperative weight maintenance in a hernia center.
Rasador ACD, Balthazar da Silveira CA, Mardian T … +6 more , Easter R, Grezenko H, Salevitz N, Deka V, Gillespie T, Ballecer C
Hernia · 2026 Mar · PMID 41790157 · Publisher ↗
INTRODUCTION: Preoperative rehabilitation programs may improve surgical outcomes. As postoperative weight gain is a risk factor for hernia recurrence, we aimed to evaluate the impact of a weight loss program on preoperat...
INTRODUCTION: Preoperative rehabilitation programs may improve surgical outcomes. As postoperative weight gain is a risk factor for hernia recurrence, we aimed to evaluate the impact of a weight loss program on preoperative body mass index (BMI) reduction and surgical decision-making. METHODS: Patients with ventral hernia enrolled in the weight loss program between 2021 and 2023 were retrospectively assessed. Patients with early follow-up loss were excluded. Demographic and clinical data were collected. Weight was assessed at initial visit, preoperatively, postoperatively, and at last follow-up. Our protocol focuses on weight loss, smoking cessation, diabetes optimization, and services such as Botulinum toxin injection and physical therapy for abdominal strength. Statistical analyses were performed using R. RESULTS: Of 578 patients, 165 (28.5%) entered the program; 109 met inclusion criteria (53% female; mean age 59 ± 11 years). Median prehabilitation duration was 104 days with three clinic visits. Median weight and BMI reductions were − 5 kg and − 1.9 kg/m², respectively. Recurrent hernia was associated with greater preoperative weight loss, while residence in socioeconomically distressed communities was associated with weight gain. 59 patients (54.1%) underwent surgery and had lower final BMI and greater weight loss (p < 0.001). Surgical completion was less likely among non-White patients. Most underwent robotic repair (85%), and no major complications or recurrences occurred. Pre- and postoperative weight changes were not correlated. CONCLUSION: Our prehabilitation demonstrated meaningful BMI reduction and low postoperative morbidity in patients who engaged in the program. While prehabilitation might reduce recurrence risk, larger randomized and group-controlled studies are needed to confirm long-term benefits.
A practical algorithm for the management of mesh infection in abdominal wall surgery: learnings after 20 years of experience.
Bueno-Lledó J, Carreño-Sáenz O, Martinez-Hoed J … +2 more , Bonafé-Diana S, Pous-Serrano S
Hernia · 2026 Mar · PMID 41790141 · Publisher ↗
INTRODUCTION: Mesh-related complications, particularly mesh infections (CMIs), remain a serious clinical challenge with significant morbidity, increased healthcare costs, and negative impacts on patient quality of life....
INTRODUCTION: Mesh-related complications, particularly mesh infections (CMIs), remain a serious clinical challenge with significant morbidity, increased healthcare costs, and negative impacts on patient quality of life. This article proposes a comprehensive protocol for managing CMIs in abdominal wall hernia repair (AWHR), synthesising our experience about this treatment after 20 years and evidence from recent clinical studies and addressing key management controversies. METHODS: A retrospective analysis was conducted using a prospectively maintained database of patients diagnosed with CMI who underwent elective open AWHR between January 2004 and May 2024 at a tertiary referral centre. CMI was diagnosed by detecting pathogenic microorganisms in periprosthetic fluid collected via surgical drainage or ultrasound-guided percutaneous aspiration after AWHR. Mesh explantation was defined as any subsequent procedure in which the prosthesis was partially or completely removed. RESULTS: Over the 20-year study period (January 2004 to May 2024), 3,892 AWHRs were performed at our hospital. At a median of 31.6 months (range: 15–55 months) of postoperative follow-up, 128 cases of CMI were reported, of which 84 cases were clinically diagnosed within one year of AWHR and 44 cases after one year. The overall CMI rate after AWHR was 3.2%. Of these cases, 118 (92.1%) patients required mesh explantation as the definitive treatment. The most frequent clinical presentation of CMI was postoperative chronic sinus tract drainage (94%) and mesh extrusion through the wound (6%). We observed 32.2% postoperative surgical site occurrences in our study in both management approaches. The overall recurrence rate after prosthesis explantation was 16.1%, and reinfection of the new mesh was 5%; all patients were reported in the two-stage management approach. CONCLUSIONS: CMI following AWHR remains one of the most challenging complications in hernia surgery, despite advances in surgical techniques and materials. The establishment of an algorithm incorporating these insights is critical to improving clinical outcomes and optimising mesh infection management.
Robotic preperitoneal lateral hernia repair: technical tips and pitfalls.
McDougall H, Eason A, Al-Mansour MR
Hernia · 2026 Feb · PMID 41758388 · Publisher ↗
BACKGROUND: Lateral hernias are uncommon abdominal wall defects that pose significant surgical challenges due to their unique anatomy and limited published data guiding repair methods. This study aims to evaluate the fea...
BACKGROUND: Lateral hernias are uncommon abdominal wall defects that pose significant surgical challenges due to their unique anatomy and limited published data guiding repair methods. This study aims to evaluate the feasibility and short-term outcomes of a robotic assisted minimally invasive approach for lateral hernia repair. METHODS: A single-institution, retrospective case series was conducted with 15 patients who underwent robotic preperitoneal lateral hernia repair. Demographics, operative considerations, and short-term outcomes were recorded and analyzed. RESULTS: The median age was 65 years, 73% were females (n = 11), and median body mass index was 29 kg/m. American Society of Anesthesiology classes were 3 (n = 11; 73%) and 2 (n = 4; 27%). Most hernias were incisional (n = 10), with traumatic (n = 2), and superior lumbar (n = 2) comprising the remainder. Left sided (n = 13) hernias were more common than right (n = 2). Two were recurrent with prior mesh. Median defect length and width were 7 and 9 cm, respectively. Median operative time was 199 min, and median blood loss was 20 mL. Median follow-up time was 180 days. Of the 12 cases who returned for follow-up, there was 1 (8%) recurrence, 1 (8%) reoperation and readmission after 30 days. The most frequent 30-day complication was a self-resolving seroma. (n = 3.20%), and no mortalities were observed. CONCLUSIONS: Our case series of 15 patients indicates robotic-assisted lateral hernia repair as a feasible approach with acceptable short and mid-term outcomes, though interpretation is limited by small sample size and variable follow-up. Preoperative imaging and in-depth knowledge of lateral anatomy proved essential for optimizing outcomes.
Long-term outcomes of IPOM plus and eTEP Rives-Stoppa techniques for midline incisional ventral hernias.
Ivakhov GB, Kuzmauskas D, Titkova SM … +4 more , Kalinina AA, Andriyashkin AV, Ekaterinina SA, Sazhin AV
Hernia · 2026 Feb · PMID 41758373 · Publisher ↗
BACKGROUND: Incisional ventral hernia repair remains important and one of the most complex problems in abdominal wall reconstruction surgery. Introduction of extended-view totally extraperitoneal (eTEP) approach changed...
BACKGROUND: Incisional ventral hernia repair remains important and one of the most complex problems in abdominal wall reconstruction surgery. Introduction of extended-view totally extraperitoneal (eTEP) approach changed significantly the concept of incisional ventral hernia repair. However, long-term results for the eTEP Rives-Stoppa (eTEP RS) remains under-investigated. This study aimed to evaluate the long-term outcomes of IPOM plus and eTEP RS techniques for midline incisional ventral hernias based on CT scan data and quality-of-life (QoL) assessment. MATERIALS AND METHODS: A single-center, retrospective cohort study was conducted based on data from 117 patients with midline incisional ventral hernias who underwent either IPOM plus (n = 42), or eTEP RS (n = 75) from March 2018 to December 2022. Long-term outcomes were assessed by physical examination and CT scans at rest and during the Valsalva maneuver with a follow-up of more than one and half year. QoL was assessed using the Carolinas Comfort Scale (CCS) and the EuraHS quality-of-life score (EuraHS-QoL). RESULTS: Early postoperative complications were comparable; a larger mesh size was used in the eTEP RS group (p < 0.001). Long-term outcomes, assessed in 80 (68.4%) patients, demonstrated a significantly lower hernia recurrence rate in the eTEP RS group (2% vs. 19.3%, p = 0.012). A normal postoperative CT scan (without postoperative abdominal wall changes) was confirmed in 89.8% of eTEP RS patients and 58.1% in the IPOM plus group (p = 0.0009). Both the CCS and EuraHS-QoL scores were significantly better in the eTEP RS group (p < 0.05). Patients with normal CT scans had better results of QoL comparing with those who had recurrence, posterior rectus sheath (PRS) rupture or bulging. CONCLUSION: Long-term follow-up demonstrates less hernia recurrence rate and higher QoL for eTEP RS in comparison with IPOM plus procedure for midline incisional ventral hernia repair that does not require separation of components. Bulging should be considered as a significant adverse event along with recurrence, since both are associated with a deterioration in the QoL. Prospective trials are needed to determine the optimal technique of minimally invasive procedure for midline ventral hernia repair.
India first tele-robotic hernia repairs using the SSI mantra system: a feasibility study.
Bhandari M, Bhandari M, Kosta S … +4 more , Mathur W, Reddy M, Singh M, Bhandari V
Hernia · 2026 Feb · PMID 41758367 · Publisher ↗
BACKGROUND: Tele-robotic surgery represents an evolving model for delivering advanced surgical care using robotic platforms operated from a physically separate console within a connected institutional network. AIM: To ev...
BACKGROUND: Tele-robotic surgery represents an evolving model for delivering advanced surgical care using robotic platforms operated from a physically separate console within a connected institutional network. AIM: To evaluate the feasibility, safety, and short-term outcomes of robotic tele-robotic inguinal hernia repair using the SSI Mantra system in a simulated tele-robotic surgery model. METHODS: This prospective case series involved ten adult patients with primary inguinal hernias including six indirect and four direct operated in July 2025. All surgeries were performed using the SSI Mantra robotic platform, with the surgeon operating remotely from a console within the same institutional network in different locations. Operative and postoperative data were collected and analyzed descriptively. RESULTS: All ten procedures were completed successfully without conversion or device malfunction. The mean docking time was 7 min, console time 36.8 ± 4.5 min, and total operative time 42.6 ± 5.3 min. Intraoperative blood loss was < 20 ml in all cases. No intraoperative complications occurred. Patients were ambulated the same day and resumed oral intake within 24 h. The average hospital stay was 1.6 ± 0.4 days, and pain was well-managed with a mean VAS score of 2.1 on postoperative day one. No readmissions or early wound complications were noted. CONCLUSION: This case series marks a in documenting India’s first clinical experience with robotic tele-robotic inguinal hernia repair using the SSI Mantra system. We emphasize that the outcomes reported are restricted to short-term feasibility and early postoperative safety, not long-term efficacy or recurrence outcomes.
How do we evaluate the remodeling and regeneration of absorbable meshes? Multi-dimensional evaluation parameters from multi-species.
Ding F, Luo Y, Liu D … +10 more , Niu M, Liu Y, Yi S, Du W, Zhao Y, Wang Z, Wang Z, Wang Y, Liu W, Ma B
Hernia · 2026 Feb · PMID 41758353 · Publisher ↗
PURPOSE: This review aimed to systematically synthesize and standardize evaluation parameters for preclinical studies of absorbable meshes in abdominal wall hernia repair models. METHODS: A comprehensive database search...
PURPOSE: This review aimed to systematically synthesize and standardize evaluation parameters for preclinical studies of absorbable meshes in abdominal wall hernia repair models. METHODS: A comprehensive database search was conducted to identify comparative studies on the remodeling and regenerative properties of absorbable meshes in animal models of abdominal wall hernia. Stratified analysis of dimensional indicators was performed across species, and study characteristics, epidemiological data, and key model attributes were visually summarized and analyzed. RESULTS: Remodeling and regenerative properties were assessed across seven major dimensions: inflammatory response, scaffold degradation, tissue integration, neovascularization, extracellular matrix (ECM) deposition, cellular infiltration, and fibrotic encapsulation. Evaluation methods encompassed histological analysis, molecular assays, general observation, and biomechanical testing, with outcomes reported in qualitative, quantitative, or combined formats. Inflammatory response, scaffold degradation, tissue integration, and neovascularization emerged as the most frequently assessed metrics. Histological assessment was the predominant evaluation method, and qualitative data presentation was most common. Species-stratified analysis revealed that rats and rabbits were the most frequently used models. Rat studies primarily focused on ECM deposition, inflammation, and tissue integration, whereas rabbit studies emphasized ECM deposition and inflammatory response. CONCLUSION: Inflammatory response, scaffold degradation, tissue integration, neovascularization and ECM deposition constitute core dimensions for evaluating tissue remodeling and regeneration. However, current studies show substantial inconsistency in endpoint selection and dimensional emphasis, with limited diversity in measurement techniques and a lack of consensus across species-specific models. Future research should establish species-specific core outcome sets and adopt multidimensional strategies to enable comprehensive evaluation of absorbable mesh performance.
The impact of active smoking on postoperative morbidity and hernia recurrence following abdominal wall reconstruction: long-term follow-up.
Messer N, Horowitz A, Miller BT … +10 more , Beffa LRA, Petro CC, Prabhu AS, Huang LC, Karin E, Kanani F, Nizri E, Lahat G, Szold A, Rosen MJ
Hernia · 2026 Feb · PMID 41758246 · Full text
INTRODUCTION: Active smoking is widely regarded as a risk factor for wound morbidity and adverse outcomes in abdominal wall reconstruction (AWR), often serving as a contraindication to elective repair. However, its indep...
INTRODUCTION: Active smoking is widely regarded as a risk factor for wound morbidity and adverse outcomes in abdominal wall reconstruction (AWR), often serving as a contraindication to elective repair. However, its independent impact on long-term complications remains poorly characterized. METHODS: This study utilized the prospectively maintained ACHQC registry, included patients who underwent open, elective, clean ventral hernia repair (VHR) with transversus abdominis release (TAR) and permanent synthetic mesh at a high-volume AWR center between February 2019 and December 2022. All active smokers during this period were propensity matched in a 1:3 ratio to never-smokers based on demographics, comorbidities, and operative characteristics. Outcomes were assessed at early (30-day) and long-term (≥ 24 months) timepoints. Primary endpoints included wound morbidity, mesh-related complications and hernia recurrence. RESULTS: A total of 106 active smokers were propensity-matched to 295 never-smokers. Baseline demographics and operative variables were well balanced. At 30 days, there were no significant differences in surgical site infection (SSI) (9.4% vs. 9.2%, p = 0.92), surgical site occurrence (SSO) (21.5% vs. 17.6%, p = 0.48), or surgical site occurrence requiring procedural intervention (SSOPI) (9.4% vs. 9.2%, p = 0.92). At 24 months, rates of SSO (1.9% vs. 0.7%, p = 0.81), SSI (0% vs. 0.3%, p > 0.99), SSOPI (0% vs. 0.7%, p > 0.99), mesh infection (0.9% vs. 0%, p > 0.99), and reoperation were low and statistically similar. Hernia recurrence at ≥ 24 months was 4.7% in smokers vs. 7.8% in never-smokers (p = 0.15). CONCLUSION: In this analysis, active smoking was not associated with increased risk of clinically significant wound morbidity, mesh-related complications, SSOPI, or hernia recurrence. These findings support a patient-centered approach wherein smoking cessation is strongly encouraged but not mandated prior to surgical repair in appropriately selected individuals.
Slowly absorbable suture for fascial defect closure in open incisional hernia mesh-repair is associated with decreased long-term recurrence: a nationwide cohort study.
Marckmann M, Henriksen NA, Christoffersen MW … +1 more , Kiim KS
Hernia · 2026 Feb · PMID 41746405 · Full text
PURPOSE: Recurrence after incisional hernia repair is an important outcome measure with rates still ranging high. For open incisional hernia repair a mesh-based technique with fascial defect closure is recommended, but t...
PURPOSE: Recurrence after incisional hernia repair is an important outcome measure with rates still ranging high. For open incisional hernia repair a mesh-based technique with fascial defect closure is recommended, but there is no evidence supporting the choice of suture used for the defect closure. Slowly absorbable suture has been advised as reducing the risk of primary incisional hernia formation after abdominal surgery, but whether this applies as best choice compared to non-absorbable suture in open incisional hernia repair with mesh is undetermined. METHOD: This was a nationwide registry study with a 100% follow-up from 2007 to 2022. Eligibility criteria were elective open incisional hernia surgery, mesh-based technique, and fascial defect closure with slowly absorbable or non-absorbable suture. The 5-year cumulative incidence of reoperation for hernia recurrence was determined. Confounders were included in multivariate regression analyses. RESULTS: A total of 3393 patients were included. Mean (sd) age was 60.6 (13) years and 50% were females. Mean horizontal defect size was 6.4 (4.7) cm and 1900 (56%) patients had vertical incisions. Incidence of 90-day surgical reintervention was 143 (4.2%). Median (IQR) follow-up was 3.5 (1.6–3.8) years, and 249 (7.3%) patients underwent operation for recurrence. Cox regression analysis showed that non-absorbable suture was associated with a significantly increased risk of operation for recurrence compared to slowly absorbable (HR 1.33, CI 1.01–1.76, P = 0.043). Type of suture was not associated with increased risk of 90-day reoperation. CONCLUSION: Using a slowly absorbable suture for fascial closure is associated with a decreased risk of long-term hernia recurrence compared to non-absorbable suture after open incisional hernia mesh-repair.
Robotic mini- or less open sublay for anterior abdominal wall hernia repair using the da Vinci single port robotic platform (SP MILOS): a preclinical feasibility study.
Schroeder AD, Florin JL, Johnson CJ … +5 more , Chen DC, Ballecer C, Schroeder M, Gerhart C, Reinpold W
Hernia · 2026 Feb · PMID 41733798 · Full text
PURPOSE: Endoscopic Mini or Less Open Sublay (eMILOS) is a transhernial endoscopically assisted approach for anterior abdominal wall hernia repair that has demonstrated excellent long-term outcomes. Performed through a s...
PURPOSE: Endoscopic Mini or Less Open Sublay (eMILOS) is a transhernial endoscopically assisted approach for anterior abdominal wall hernia repair that has demonstrated excellent long-term outcomes. Performed through a small skin incision directly over the hernia, the eMILOS technique minimizes additional access trauma, but remains technically demanding with conventional instruments. This study investigates the preclinical feasibility of adapting the da Vinci SP system to perform the transhernial SP MILOS technique. METHODS: This preclinical study evaluated the technical feasibility of performing daVinci SP MILOS hernia repair using human cadavers. The da Vinci SP robotic platform and its standard instruments were employed. Procedural steps, technical considerations, limitations, and potential advantages were systematically documented. RESULTS: The procedure was completed through a 1.8-cm skin incision. Correct placement of the Access Port (AP) and defining the custom remote center (CRC) at the posterior fascial edge was essential for optimal trocar orientation and to limit collisions with the incision. The AP can be positioned below the skin or below the fascia depending on work flow and surgeon preference. The retrorectus space was developed robotically from xiphoid to pubis, with full 360° transhernial exposure. Transversus abdominis release and lateral dissection into the preperitoneal and pretransversalis planes were successfully achieved. CONCLUSION: In this preclinical cadaveric study, the SP MILOS technique provided 360° transhernial access to the retrorectus space without platform repositioning. Our initial experience supports its feasibility as a new single-port robotic option for ventral hernia repair, eliminating access trauma to the abdominal wall through a single, minimal skin incision.
Correction to: Management strategies for anterior cutaneous nerve entrapment syndrome: a scoping review.
Troyer A, Allaeys M, Verelst F … +1 more , Berrevoet F
Hernia · 2026 Feb · PMID 41733815 · Publisher ↗
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Perineal hernia following extra-levator abdominoperineal resection: prevalence, associated risk factors and types of perineal closure. a single-centre descriptive study.
Martínez AF, de Las Casas SG, Vera GC … +6 more , Cilla RV, Bocanegra MG, Rubio AV, Carneros VJ, Ramos Rodríguez JL, Manuel-Vázquez A
Hernia · 2026 Feb · PMID 41733777 · Publisher ↗
PURPOSE: Primary aim was to analyse the incidence of perineal hernia (PH) after elective extra-levator abdominoperineal resection (ELAPE), comparing pelvic floor closure techniques. Secondary aim was to assess postoperat...
PURPOSE: Primary aim was to analyse the incidence of perineal hernia (PH) after elective extra-levator abdominoperineal resection (ELAPE), comparing pelvic floor closure techniques. Secondary aim was to assess postoperative wound complications and associated risk factors. METHODS: A retrospective, descriptive, single-centre study (2017–2023), was conducted on consecutive patients undergoing elective ELAPE. RESULTS: Fifty-seven patients were included. Direct closure or myocutaneous flap was performed in 31.6% (18 patients) and mesh reinforcement in 68.4% [39 patients – 34 double-component, 3 biological, 2 non-specified material –]. No differences referred to PH prevalence were found comparing the closure techniques, except higher additional organ resection in the direct group – 2 patients versus no patients in the mesh group (p 0.034) –. PH incidence was 3.5% (2 patients): one patient from the direct group and one patient from the mesh group (p 0.584). Only one patient required PH repair. Perineal wound (PW) complications accounted for 38.9% (7 patients) in the direct closure and 25.6% (10 patients) in the mesh group. The only myocutaneous flap case developed PW dehiscence. No differences in PW complications were observed regarding type of radiotherapy (long-term versus short-term) (p 0.248). Median follow-up was 51.9 months: 62.4 months in the mesh group versus 36.7 months in the direct closure group. CONCLUSION: In our study, the use of mesh reinforcement in ELAPE to prevent PH did not demonstrate superiority over pelvic floor direct closure. However, a tendency toward a higher risk of PW complications in the direct closure group was observed.
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